Provider Demographics
NPI:1063853273
Name:HARRIS, SARAH F (MED MA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:F
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MED MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 GRAND CONCOURSE
Mailing Address - Street 2:APT 2F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-5816
Mailing Address - Country:US
Mailing Address - Phone:336-380-0652
Mailing Address - Fax:
Practice Address - Street 1:1675 GRAND CONCOURSE
Practice Address - Street 2:APT 2F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-5816
Practice Address - Country:US
Practice Address - Phone:336-380-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633649121174400000X
NY646344121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist